Hospital Practices and Research

Abstract Background: Cutaneous larva migrans (CLM) is a parasitic infection caused by the accidental penetration of canine hookworm larvae into the superficial layers of human skin. Although typically self-limiting, delayed diagnosis may result in complications such as secondary infections or allergic reactions.
Case Presentation: The case involved a 54-year-old man with a history of hypertension who presented with a creeping, erythematous lesion on his left leg, accompanied by severe pruritus and a history of contact with a pet dog. After confirming the dog’s hookworm infection and conducting further clinical evaluation, a diagnosis of CLM was established. Treatment with albendazole and an antihistamine resulted in complete resolution of the patient’s symptoms.
Conclusion: Although CLM is typically a self-limiting condition, timely initiation of treatment can significantly reduce the duration and severity of symptoms. The growing trend of pet ownership has increased the risk of CLM transmission, underscoring the importance of implementing effective preventive measures.

Abstract Background: Leishmania major is one of the main causative agents of cutaneous leishmaniasis in many world regions, including Iran. Common treatments for this disease include pentavalent antimonial compounds, amphotericin B, and paromomycin-based formulations. However, these treatments face challenges such as drug resistance, high toxicity, and high costs. Consequently, there is a growing need for alternative therapeutic approaches.
Objectives: The present study evaluates the inhibitory effect of nano-chitosan loaded with Allium ursinum (A. ursinum) extract against L. major under in vitro conditions.
Methods: Initially, chitosan/extract nanoparticles (NChi/Ex) were synthesized by loading A. ursinum extract onto chitosan, and their physicochemical properties were analyzed using Fourier-transform infrared spectroscopy (FTIR), dynamic light scattering (DLS), and field emission scanning electron microscopy (FESEM). Subsequently, Leishmania major parasites were cultured in RPMI 1640 medium, and the effect of NChi/Ex on the parasites was assessed using the MTT assay.
Results: The results showed that the average size of the synthesized nanoparticles was 145.3 nm, with a polydispersity index (PI) of 0.277, indicating a relatively uniform particle distribution. The FTIR spectrum confirmed the successful loading of A. ursinum extract onto chitosan, as characteristic peaks corresponding to the functional groups of both components were observed. The NChi/Ex nanoparticles exhibited a dose-dependent inhibitory effect, with the highest inhibition occurring at a concentration of 50 µg/ml after 48 hours, achieving 100% inhibition of Leishmania major.
Conclusion: The results demonstrated that NChi/Ex exhibited greater efficacy than chitosan or A. ursinum extract alone. This study underscores the potential of chitosan nanoparticles loaded with A. ursinum extract as a promising therapeutic strategy against Leishmania major, with potential applications in laboratory research and possibly in animal models.

Abstract Background: Cutaneous leishmaniasis (CL) is one of the most significant parasitic diseases in Iran and other endemic regions. Existing standard treatments face challenges, including drug toxicity, difficulty in administration, and parasite resistance.
Objectives: In this study, nano chitosan based on dendrimers (NChi), which has antibacterial and antiparasitic effects, was used to target Leishmania major in vitro.
Methods: NChi was synthesized first. Fourier transform infrared spectroscopy (FTIR) and dynamic light scattering (DLS) were used to confirm the synthesis and measure the size, while scanning electron microscopy (SEM) was employed to examine the nanostructure's morphology. After assessing the cytotoxicity of the NChi on the macrophage cell line, the antileishmanial effects of NChi were evaluated after 24 and 48 hours. Finally, the data were statistically analyzed using the ANOVA test in SPSS software.
Results: The results demonstrated that NChi, with a size of 128.5 nm, is suitable for drug delivery. FTIR analysis confirmed the successful synthesis of the nanostructure by indicating the attachment of chitosan to the dendrimer. The MTT assay on macrophage cells showed no cytotoxicity of the synthesized nanocomposite at the applied concentration. Moreover, after 48 hours, the NChi exhibited significant antileishmanial activity, achieving 100% growth inhibition at a concentration of 40 µg/ml.
Conclusion: This study highlights NChi as a more effective alternative to conventional chitosan for leishmaniasis due to its optimal size, stability, and potent anti-promastigote activity, positioning it as a promising substitute for chemical drugs like glucantime.

Abstract This highlights the significance of parasitic infections as an important and overlooked aspect of infectious diseases amid the COVID-19 pandemic. Despite the focus on viral and bacterial infections, parasitic infections continue to pose a substantial public health challenge, especially in areas with restricted access to healthcare. The interaction between parasitic infections and COVID-19, including possible co-infections and their impact on disease severity, requires further investigation...

Abstract Background: Toxoplasmosis, caused by Toxoplasma gondii, is a globally prevalent parasitic infection that often presents with nonspecific symptoms, making diagnosis challenging, especially in immunocompetent individuals.
Case Presentation: We report a case of a 22-year-old immunocompetent male presenting with cervical lymphadenopathy, fever, and flu-like symptoms, initially misdiagnosed as influenza or COVID-19. Despite symptomatic treatment, his condition worsened. Serological testing confirmed acute toxoplasmosis (IgM: 6.64 IU/ml; IgG: 44 IU/ml). Ultrasonography showed hypoechoic cervical lymph nodes, consistent with lymphadenopathy. Treatment with azithromycin, pyrimethamine, and folinic acid for 10 days led to complete symptom resolution.
Conclusion: This case highlights the importance of considering toxoplasmosis in the differential diagnosis of cervical lymphadenopathy, especially in patients with persistent flu-like symptoms. Early serological testing and imaging are crucial for accurate diagnosis and timely intervention. The rapid clinical improvement observed underscores the effectiveness of antiparasitic therapy in immunocompetent individuals. Greater clinician awareness of the diverse presentations of toxoplasmosis is essential to prevent misdiagnosis and optimize patient outcomes.

Abstract Background: Different studies have shown that despite the expanding number of antifungal drugs, the death rate caused by Candida species has increased during the recent decades due to drug resistance occurrence.
Objectives: The present study aims to identify molecular structure and evaluate drug susceptibility in Candida species isolated from bronchoalveolar lavage fluid in patients diagnosed with hematological malignancies.
Methods: In this cross-sectional study, 54 clinical specimens were taken from the bronchoalveolar lavage of patients. The suspected colonies were investigated by microscopic examination and subsequent passages were evaluated according to standard operating procedures and specification of the type of colony color prescribed by CHROMagar to isolate the yeast. The sequencing method (ITS1, ITS4) was used to approve Candida species. Finally, susceptibility test was carried out according to M27S-3 and M38-A2 micro-dilution methods.
Results: Among 54 samples investigated with culture and PCR methods, 33 Candida species were identified in patients with hematological malignancies. Candida albicans (75.7%) was the most common fungal isolate. Results of drug susceptibility tests showed that the isolated C. albicans (n = 2), C. glabrata (n = 1), and C. tropicalis (n = 1) from patients with hematological malignancies were resistant to fluconazole. The present study showed that the prevalence of C. albicans was higher than other fungal species among patients with hematological malignancies.
Conclusion: Candida species are more susceptible to voriconazole, amphotericin B and Caspofungin. Therefore, identification of candida species along with their antifungal susceptibility pattern can help clinicians to better treat patients.

Abstract Background: Parasitic infections are most prevalent in developing nations and among individuals with weakened immune systems or immunocompromised.
Objectives: Due to the lack of epidemiologic information on such infections, the prevalence of enteric, respiratory, and urogenital parasites was investigated among patients in teaching hospitals in Alborz province, Iran.
Methods: In this cross-sectional study, 1248 samples were collected from January to July 2023. Microscopic examination was performed using direct wet mount, formalin-ether concentration techniques, and trichrome staining. To detect Enterobius vermicularis parasite, we have used the Scotch test method.
Results: The prevalence of parasitic infections was 7.1%. The most commonly identified parasitic infections in the study were Entamoeba histolytica/dispar (29 cases, 2.3%), and Blastocystis sp. (26 cases, 2.1%). 40.2% of our studied cases showed gastrointestinal symptoms and the majority of symptoms were relating to anorexia and abdominal pain.
Conclusion: Given the significant global prevalence of parasitic infections, it is crucial to identify and treat infected individuals, implement urban water improvement programs, avoid the use of human feces as fertilizer in agriculture, and maintain public, and personal hygiene.